Inverting papilloma of the temporal bone: case report and meta-analysis of risk factors

Jasper Shen, Fred Baik, Mahmood F Mafee, Michael Peterson, Quyen T Nguyen
Otology & Neurotology 2011, 32 (7): 1124-33

OBJECTIVE: To review the literature on inverting papilloma of the middle ear and mastoid with a focus on familiarizing clinicians with its presentation and cause and to discuss its epidemiologic, diagnostic, and therapeutic issues.

STUDY DESIGN: Search of the English literature for cases of inverted papilloma of temporal bone in conjunction with 1 new case presenting at the UCSD Medical Center.

SETTING: Academic, tertiary referral hospital.

PATIENTS AND INTERVENTIONS: The patient underwent radical mastoidectomy with adjuvant therapy, revealing substantial tumor growth filling the external ear canal and middle ear space and obliterating much of the mastoid air cells. Histopathology confirmed inverted papilloma of the middle ear and mastoid. The patient underwent postoperative radiation and has been free of the disease at 6 months of follow-up.

RESULTS: A total of 25 inverted papillomas of the temporal bone cases from the English literature between 1987 and 2010 were reviewed. This tumor commonly presents with hearing loss and otorrhea. Although rare, temporal inverted papillomas display a higher incidence of malignancy (40%) compared with sinonasal papillomas. Secondary and recurrent temporal disease was frequently associated with carcinomatous changes. Although recurrence rate is higher in temporal inverted papillomas than that in sinonasal disease, this difference becomes magnified in cases with more aggressive surgical approaches. We present a case of multicentric inverted papillomas in the middle ear and the sinonasal cavities.

CONCLUSION: Efforts to define the cause of middle ear papilloma have been challenging because of its exceeding rarity. Although published literature shows that middle ear papillomas differ from their sinonasal counterparts pathologically and epidemiologically, these papillomas parallel in the unique characteristics of local aggressiveness, tendency to recur, association with malignancy, and multicentricity. Surgical resection with adjuvant radiation therapy and long-term follow-up with magnetic resonance imaging is advocated in the successful management of middle ear inverted papillomas.

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